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C.Y. Lowder1, P.K. Kaiser, M.D.2A,
P.Sullivan, M.D.2A, M.A. Meziane, M.D.2B, T.W. Rice, M.D.2A,
D.M. Meisler, M.D.2A.
1Department of Ophthalmology,
Cleveland Clinic, Cleveland, OH;
ACole Eye Institute,
BCole
Eye Institution,
2The Cleveland Clinic Foundation, Cleveland, OH.
Purpose: To describe the usefulness of chest computerized tomography (CT) in the evaluation of chronic uveitis in elderly women. Design: Prospective, non-comparative, case series.
Methods: All elderly women (over age 60) seen between June 1997-June 2001 with chronic uveitis consisting of either iridocyclitis, vitritis and/or multifocal choroiditis underwent a battery of diagnostic laboratory studies and chest CT.
Results: Twenty-eight patients (median 72+5.2 years, range 61-83) were included. The diagnostic work-up included serum angiotensin converting enzyme level, serum lysozyme, rapid plasma reagin level, fluorescent treponemal antibody-absorption test, purified protein derivative skin test, and chest radiographs in all patients failed to establish a conclusive diagnosis. Hilar adenopathy was seen in 3 chest x-rays, non-specific old granulomas or parenchymal nodules were present in 5 patients. Chest CT showed hilar and/or mediastinal lymphadenopathy in 15 patients. Histopathologic confirmation showing non-caseating granulomas consistent with sarcoidosis was obtained in fourteen patients: ten by mediastinoscopy, two by conjunctival biopsy, one by nasal biopsy, and one by vitreous biopsy.
Conclusion: Chest CT is more sensitive than chest X-ray in the evaluation of elderly female patients with uveitis for identifying mediastinal lymphadenopathy and other lesions suggestive of sarcoidosis as well as to help guide tissue confirmation to rule out other diagnoses including lymphoma.
Commercial Relationship: C.Y. Lowder, None; P.K. Kaiser, M.D., None; P. Sullivan, M.D., None; M.A. Meziane, M.D., None; T.W. Rice, M.D., None; D.M. Meisler, M.D., None.
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